title: Use of pelvic computed tomography and sonography in women of reproductive age in the emergency department.
abstract: OBJECTIVE
  The purpose of this study was to review use of pelvic computed tomography (CT) and sonography in the emergency department for women of reproductive age and to identify cases in which sonography might have been adequate.
  
  
  METHODS
  Computed tomographic and sonographic examinations of the pelvis performed on women up to 55 years of age in our emergency department during a 6-month period were reviewed. Repeated CT and CT with indications for which sonography would not be the first-line imaging modality (eg, diverticulitis and trauma) were excluded. For the sonographic-only assessment, repeated sonography and sonography with indications for which CT would not be the first-line imaging modality (eg, vaginal bleeding) were excluded. Patient referral indications, imaging diagnoses, and discharge diagnoses were compared for the groups with CT only, CT first, sonography first, and sonography only.
  
  
  RESULTS
  Of 509 women who underwent CT, 407 (80%) underwent CT only; 54 (11%) underwent CT first; and 48 (9%) underwent pelvic sonography first. The percentages with negative CT findings were 42%,17%, and 50%, respectively. Overall, 63 (CT only), 38 (CT first), and 12 (sonography first) patients had CT diagnoses of pelvic conditions only (113 of 509 women [22%]). Of the patients with CT and discharge diagnoses of pelvic conditions, 36 of 44 (82%) had CT only or CT first; 58 of 110 (53%) of cases with sonography only showed acute pelvic conditions.
  
  
  CONCLUSIONS
  Twenty-two percent of pelvic CT examinations performed in women of reproductive age in our emergency department showed only pelvic conditions, suggesting that sonography would have been a reasonable primary imaging test for these patients.
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Asch
authors.forename: Sejal
authors.initials: S
authors.lastname: Shah
authors.forename: Tarina
authors.initials: T
authors.lastname: Kang
authors.forename: Deborah
authors.initials: D
authors.lastname: Levine
mesh_terms: D000293:Adolescent; D000328:Adult; D001900:Boston / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017699:Pelvic Pain / Q000175:diagnosis* / Q000453:epidemiology*; D010388:Pelvis / Q000000981:diagnostic imaging*; D015995:Prevalence; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014463:Ultrasonography / Q000706:statistics & numerical data*; D014600:Utilization Review; D055815:Young Adult
keywords: acute abdominal pain; acute pelvic pain; pelvic sonography; quality assurance